“There’s just no reason any more not to do these relatively simple things,” says Peter Pronovost, M.D., professor of medicine and medical director of Johns Hopkins’ Center for Innovation in Quality Patient Care, who led researchers in their review of 103 Michigan ICUs. “A common misperception among hospital-based clinicians is that it often costs much too much money and time to significantly improve patient safety,” says Pronovost. “Our data destroys this myth.”

In the hospital efforts included training physicians and nurses about infection control; using special, standardized central-line supply carts that are controlled for one-time use; requiring use of a cockpit-style “checklist” to ensure adherence to infection-control practices such as hand washing; avoiding catheter placement through the femoral artery in the groin, an area notoriously difficult to keep sterile; using and changing gloves, gowns and masks for each procedure; cleaning patients’ skin with chlorhexidine; and removing catheters as soon as possible, even if there’s a chance they might be needed again at some point.

The safety plan also requires immediate “stop now” orders by any member of the health care team when a checklist is not followed to the letter and feedback to each member of the care team about the number and rates of catheter-related bloodstream infections at weekly and quarterly meetings.

The results were dramatic, Pronovost says, when the steps were implemented. The median rate of catheter-related bloodstream infections per 1,000 catheter-days decreased from 2.7 at baseline to 0 after implementation of the safety measures, and the mean rate decreased from 7.7 at baseline to 1.4 at 16 to 18 months of follow-up.